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Experts Call for Improvements in the Quality of Cancer Care

Article date:
September 11, 2013

By Stacy Simon

A new report by the Institute of Medicine (IOM) says the cancer care delivery system in the United States is in crisis and calls for across-the-board changes. In its report, Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis, the IOM says health care costs are rising, treatment decisions are often being made without regard to scientific evidence, and patients aren’t receiving help for symptoms and side effects.

The IOM is calling for patients, doctors, researchers, and federal and private organizations to reevaluate their roles and work together to make changes. The report was sponsored in part by the American Cancer Society, along with the American Society of Clinical Oncology, the Centers for Disease Control and Prevention, LIVESTRONG, the National Cancer Institute, and others.

The IOM, established in 1970 by the National Academy of Sciences to advise the nation on ways to improve health, first studied the quality of cancer care in 1999.

“I think the most important message coming out of this report,” said Rebecca Kirch, American Cancer Society director of quality of life and survivorship, “is that in this decade of evidence building, we now know from science and practice that treating the person is as important as treating the disease.”

Barriers to care

The independent committee of experts who wrote the report says one of the main problems with cancer care in the US is that it is not patient-centered. Many patients do not receive palliative care, care that focuses on relieving the symptoms caused by cancer or cancer treatment.

In addition, rising costs are making cancer care less affordable and are creating disparities in patients’ access to high quality care. The cost of cancer care is rising faster than many other fields of medicine. Estimated at $72 billion in 2004 and $125 billion in 2010, the cost is projected to reach $173 billion by 2020, according to the report.

The IOM committee also found that shortages of skilled cancer care professionals are increasing even as the population who needs their services grows. The IOM says the number of adults age 65 and older – the group most susceptible to cancer – is expected to double by 2030, and this growth will contribute to a 45% increase in the number of people developing cancer. The needs of this group are especially complex because they are more likely to have impairments and diseases in addition to their cancer that require greater need for social support and more coordination of care.

Recommendations

Quality cancer care delivery and survivorship planning, according to Kirch, means providing palliative and psychosocial care alongside oncology treatments from the beginning. The IOM committee proposes a framework of strategies for improving the quality of cancer care:

Cancer care teams should provide patients and their families with understandable information about prognosis, treatment benefits and harms, palliative care, psychosocial support, and costs. Patients with advanced cancer should receive end-of-life care appropriate to their needs, values, and preferences.

Legislative bodies, academic institutions, professional societies, and cancer care delivery organizations should work together to make sure cancer care is coordinated among different providers and that people caring for cancer patients have the necessary skills, training, and credentials.

More research should be conducted about cancer care, especially on older adults and patients with multiple health problems.

Professional organizations and the US Department of Health and Human Services (HHS) should create an information technology system to improve knowledge about cancer and inform medical decisions.

Professional organizations and HHS should develop a system for publicly reporting quality measures for cancer care.

HHS should support the development of programs that help communities provide accessible and affordable cancer care.

Citation: Institute of Medicine. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. September 10, 2013.